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Log Sheet Template
Medication disposal log
Medication disposal log
1
□
CONTROLLED MEDICATIONS DISPOSED
□
NON-CONTROLLED MEDICATIONS DISPO
SED
(NURSE + W
ITNESS TO DO
)
(2 STAFF TO DO
)
MEDICATION DISPOSAL LOG
CONSUMER
MEDICATION
NAME &
STRENGTH
RX#
AMOUNT
D
ISPOSED
METHOD OF
D
ISPOSAL
REASON FOR
D
ISPOSAL
D
ISPOSED
OF
BY
(SIGNATURE
)
WITNESSE
D BY
(SIGNATURE
)
DATE D
ISPOSE
D
*
COMPLETE ONE FORM FOR CONTROLLED MEDICATION D
ISPOSAL
AND ONE FORM FOR NON
-
CONTROLLED MEDICATION D
ISPOSAL
(REMEMBER: CONTROLLED MEDICATIONS ARE LABELED BY PH
ARMACY
WITH A RED “C”
Download
Medication disposal log
DOC: 99.9 KB | PDF: 38.7 KB (1 page)
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